Social Marketing Downunder from liberation theology to regime change

1
Social Marketing Downunder from liberation
theology to regime change

• Rob Donovan
• Social Marketing Downunder
• Wellington New Zealand March 10-11 2005

2
Social Marketing
The application of the principles and methods of
marketing to the achievements of socially
desirable goals (Kotler Zaltman 1971)
UN Declaration of Human Rights defines socially
desirable (Donovan Henley 2003)
Using marketing principles and methods to achieve
change in the social determinants of health
wellbeing (Donovan Henley 2003)
Goal substantive changes in societal
institutions to remove disparities
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Social Marketing
Identifies targets individuals to change their
behaviours via information and persuasion. Identif
ies targets environmental factors that minimise
harm. Identifies targets those in power to make
structural changes that remove barriers give
individuals the capacity and resources for
change and facilitate the adoption of desired
behaviours. Seeks changes in structures in
society that inhibit attaining human
rights. Gerard Maibach, Andreasen, Goldberg,
Lefebvre, McKee, Bill Smith,
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Changes in Marketing

• Products
• Services
• Ideas

Social Marketing

• Healthy Environments
• Health Promotion
• Health Education

Changes in Health Promotion
5
Social Marketing
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Exchange

• Originally men shared food types with women
  tools within small units
• Increasing density led to more exchange
• Habit of exchanging one thing for another led to
  division of labour, trade and specialisation of
  labour (200,000 years ago)
• Exchange brings people together cooperation,
  coalitions, alliances economic political
• Stems from basic human characteristic principle
  of reciprocity

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Capitalism (UK 1750gt) employing resources to
secure profit through a market exchange process
- or - appropriating surpluses through which one
social class controls and exploits another - Marx
(Fullerton 1988)

• The pursuit of profit and aggressive growth
• Purposeful rationality
• Freedom from govt restraints
• Efficiency, Energy,Creativity
• Unbound goals
• Disdain for tradition
• Push over or around constraints whether
  political, social, cultural, public policy and
  legislation (TI guns Alch)
• Amorality of methods (JBDUKE American Tobacco
  Company)
• Fueled by increased desire for material
  betterment but perhaps decreased satisfaction
  when we find out it aint like that but we
  nevertheless keep trying

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Capitalism Modern MarketingCapitalism required
efficient marketing and marketing reinforced and
sustained capitalism (Fullerton 1988)

• Capitalism Awesome productive resources
• Marketing Awesome distributive resources

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American Values, Capitalism Modern Marketing

• Individualism Privacy seat belts
• Equality Informality
• Time efficiency
• The future, Change Progress
• Materialism
• Goodness of humanity
• Directness Assertiveness
• Achievement, Action, Work
• Values (or myths?)
• The language of public discourse is that of
  marketing
• Althen 1988
• Martha Stewart .. Tv mag personality cooking,
  gardening,etiquette arts crafts insider trading
  prison in 2004(wa a stockbroker early career)

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How US values and commercial marketing culture
influences social marketing effortsbut
fortunately not all of them .

• Seat belts, Redlight cameras RBT
• Declare war and crash thru (and crash)
• Healthy Kids Make Healthy Communities
• Can social marketing reduce health disparities?
  illiams Kunayika SMQ 2002
• Road Crew .

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Changes in Public Health / Health Education /
Promotion

• First half of 20C social determinants,
  infectious diseases
• Second half Chronic diseases lifestyle - The
  health education era focus on the individual
  providing information teaching skills
  prevention and maintenance of good health
• Rhetoric re SES determinants . But little action

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The Gangs of New York (Herbert Asbury)
The gangster whose reign ended with the murder of
Kid Dropper was primarily a product of his
environment poverty and disorganisation of home
and community brought him into being, and
political corruption and all its attendant evils
fostered his growth his only escape from the
misery of his surroundings lay in excitement, and
he could imagine no outlets for his turbulent
spirit save sex and fighting. And many a boy
became a gangster to emulate the exploits of
some spectacular figure of the underworld, or
because of a yearning for fame and glory which he
was unable to satisfy except by acquiring a
reputation as a tough guy and a hard mug. Of
course, there were exceptionsbut in the main the
gangster was born in filth and squalor and
reared amid vice and corruption. He fulfilled his
natural destiny.
January 5, 1928
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The Gangs of New York
The gangster whose reign ended with the murder of
Kid Dropper was primarily a product of his
environment poverty and disorganisation of home
and community brought him into being, and
political corruption and all its attendant evils
fostered his growth his only escape from the
misery of his surroundings lay in excitement, and
he could imagine no outlets for his turbulent
spirit save sex and fighting. USA 2004 Virginia
Anti-gang Campaign Gangs You
lose! brochures, posters, radio tv commercials
targeting parents and children And many a boy
became a gangster to emulate the exploits of
some spectacular figure of the underworld, or
because of a yearning for fame and glory which he
was unable to satisfy except by acquiring a
reputation as a tough guy and a hard mug. Of
course, there were exceptionsbut in the main the
gangster was born in filth and squalor and
reared amid vice and corruption. He fulfilled his
natural destiny.
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UK bmj 2005 The most effective health
promotion intervention for young people would be
to improve the socioeconomic circumstances in
which they are raised and greater socioeconomic
equality in population as a whole Viner
Macfarlane 2005
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Health PromotionLalonde Report (1974)
Health Care
access
HEALTH
Environment
Human Biology
reduce hazards
smoking etc.
Lifestyle
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1980 The Black Report Report of the Working
Group on Inequalities, UK

• Social class and social inequalities rather than
  lifestyle
• 1984 Beyond Health Care, Canada
• Healthy public policy
• Creating supportive environments to promote the
  health of
• individuals
• communities
• the natural environment

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Ottawa Charter, WHO 1986

• Building healthy public policy political actions
  and interventions, including legislation,
  economic policy, taxation and organisational
  changes.
• Building supportive environments securing and
  protecting healthy environments and natural
  resources.
• Strengthening community action in setting
  priorities, making decisions, planning strategies
  and implementing them to achieve better health
• Developing personal skills including knowledge
  of health-related information
• Reorienting health services to promote health
  (as opposed to discouraging ill-health) while
  focusing on the needs of the individual as a
  whole person.

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Marmot Wilkinson

• The Whitehall studies
• Mortality morbidity related to level in
  hierarchy
• Control a major factor within and between levels

• The social gradient what you do how much you
  earn who you are where you live
• Stress
• Early life
• Social exclusion
• Working conditions
• Unemployment
• Social support
• Addiction
• Healthy food
• Transport policy
• Poverty Racism lack of Education Hopelessness

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Population Health Approach
Health Care System
Genetics
Individual Capacity Coping Skills
Economic Factors
HEALTH
Early childhood development
Social factors media Marketing, sport racism
Physical Environment asbestos, lead, water, air,
toxins
Lifestyle/personal health practices
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Upstream Downstream and the stream has become
a river .
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Family responsibility!
EPIDEMIOLOGISTS Who falls in the river? What
injuries do they receive?
PREVENTION
Signs encouraging people to jump in
Lifeguards
Speedboats
Another path
BEHAVIOURAL RESEARCH
MEDICAL
EDUCATION
Ambulances
Swimming lessons Lifeguard training
Resuscitation machines
Lifebuoys
Rails and ladders
Treatment Recovery time to treat
HARM REDUCTION
Survivor groups
Landfill to make river shallower Salt to make
more buoyant
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twas originally a dangerous cliff

• twas a dangerous cliff, as they freely
  confessed, though to walk near its crest was so
  pleasant.
• But over its terrible edge there had slipped,
• a Duke and full many a peasant.
• The people said something would have to be done,
  but their projects did not at all tally.
• Some said put a fence around the edge of the
  cliff, some an ambulance down in the valley
• From the Parable of the Dangerous Cliff,
• Joseph Malins (1895)

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• Downstream Proximal factors
• Modify the Individual
• Risk factors-Education skills
• How to say no deconstructing advtg

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Going Upstream Proximal Environmental Factors
Modify the environment Policy makers and
marketing consequences Clean air
water-Controls on sin product marketing
adoption of broader marketing eg analgesic pack
size Environmental facilitators/hazard reduction
-Fluoride approach

• Downstream Proximal factors
• Individual targeting
• Risk factors Education skills

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Who killed Princess Diana?
Would Princess Diana be alive today . . . if
her driver hadnt been affected by alcohol? if
the vehicle hadnt been speeding? if shed been
wearing her seat belt? An individual, voluntary
behaviour focus would emphasise the above
questions. An environmental (harm minimisation)
perspective would add . . . if French
authorities had followed standard practice and
installed guardrails between the concrete
pillars in the tunnel?
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The FLUORIDE approach to Weight Loss

• For
• Lowering
• Universal
• Obesity
• Rates
• Implement ideas that
• Dont demand
• Effort
• But real changes will require lots of effort on
  outr part . Maybe ok in interim, but goal is to
  involve the people
• Bray (2004)

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Further upstream Intermediate Distal
Factors Sociocultural Vulnerable group
targeting under served populnsRacism-Violence-Abu
se-Early childhood
Going Upstream Proximal Environmental
Factors Policy makers and Corporation
targetingClean air water Controls on sin
product marketing Environmental facilitators
Fluoride approach

• Downstream Proximal factors
• Individual targeting
• Risk factors Education skills

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Moerewa Problem Alcohol and drug
misuse Solution Community Clean up the town
broken windows Place for kids skateboard Public
loos celebrations Create income, busyness
building self worth empowerment www.alac.org.nz
/CaseStudy.aspx?PostingID652
Going upstream
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Upstream Modify Societal StructuresPolitical
targetingEducation Housing Employment Resource
allocation regime change
Further upstream Intermediate Distal
Factors Sociocultural Vulnerable group
targetingRacism Violence Abuse Early childhood
Going Upstream Proximal Environmental
Factors Policy makers and Corporation
targetingClean air water Controls on sin
product marketing Environmental facilitators
Fluoride approach additives to food water folate
zinc iron

• Downstream Proximal factors
• Individual targeting
• Risk factors Education skills Incentives
  threats deconstructing advtg

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Contrasting approaches to disease prevention
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issues

• Mental illness and suicide
• Racism
• Pre natal, post natal and early childhood
  pathways
• The forgotten
• Family violence
• Societal violence
• Wars Genocide
• Whole populations under sustained stress
  refugees Human rights abuses
• Global corporations
• Environmental degradation exploitation
• Displacement of Indigenous populations
• Genetic advances and neurosciences

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Identify the competitionBarriers
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Top five USA Health Indicators?

• Physical Activity 
• Overweight and Obesity 
• Tobacco Use 
• Substance Abuse 
• Responsible Sexual Behavior 
• The Leading Health Indicators will be used to
  measure the health of the Nation over the next 10
  years. Each of the 10 Leading Health Indicators
  has one or more objectives from Healthy People
  2010 associated with it. As a group, the Leading
  Health Indicators reflect the major health
  concerns in the United States at the beginning of
  the 21st century. The Leading Health Indicators
  were selected on the basis of their ability to
  motivate action, the availability of data to
  measure progress, and their importance as public
  health issues.

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• Ten Tips For Better Health UK Donaldson, 1999
• 1. Don't smoke. If you can, stop. If you can't,
  cut down.
• 2. Follow a balanced diet que? with plenty of
  fruit and vegetables.
• 3. Keep physically active.
• 4. Manage stress by, for example, talking things
  through and making time to relax. Never mind if a
  single mum wi 3 kids 24/7 responsibilities
• 5. If you drink alcohol, do so in moderation.
  Great word
• 6. Cover up in the sun, protect children from
  sunburn.dont worry about chil abuse etc
• 7. Practise safer sex. In UK probably means
  plastic bag while wearing suspenders and engaging
  inwhatn the post modernists call self pleasuring
  
• 8. Take up cancer screening opportunities. If
  they ever get to your town
• 9. Be safe on the roads follow the Highway Code.
  Whats that?
• 10. Learn the First Aid ABC airways,
  breathing, circulation. ???

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12 Pain-free Ways to a Healthier LifeBy Dr David
Butler-Jones, Canadian Medical Officer of Health,
2005

• Wash Hands.
• Exercise.
• Eat Healthier, Not More.
• Keep a Healthy Kitchen.
• Coming Down With Something? Stay Home.
• Get Your Flu Shot.
• Clean Up Those Cupboards.
• Make Your Home Safe. Play Safe.
• Travel Smart.
• Volunteer.
• Chill Out and Do Something.

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Balance rights with responsibilitiesJohn Reid
UK Health Secretary, Guardian, November 2004

• People change their own lives. People like
  Amanda Acker, a Cambridgeshire catering assistant
  who lost five stone after her GP advised her to
  join Weightwatchers. She made the change herself,
  supported by the local NHS
• Ultimately it is through their own effort that
  the disadvantaged overcome their disadvantage.
  Government intervention should supplement, not
  replace, this individual effort.
• But still must protect the weak, vulnerable the
  young but the prime responsibility rests with
  them as parents

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Ten Tips for Better Health - Dave Gordon, 1999

• 1. Don't be poor. If you can, stop. If you can't,
  try not to be poor for long.
• 2. Don't have poor parents.
• 3. Own a car.
• 4. Don't work in a stressful, low paid manual
  job.
• 5. Don't live in damp, low quality housing.
• 6. Be able to afford to go on a foreign holiday
  and sunbathe.
• 7. Practice not losing your job and don't become
  unemployed.
• 8. Take up all benefits you are entitled to, if
  you are unemployed, retired or sick or disabled.
• 9. Don't live next to a busy major road or near a
  polluting factory.
• 10. Learn how to fill in the complex housing
  benefit/ asylum application forms before you
  become homeless and destitute.

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New Zealand Public Health Public Health
Goalsgetting betterTo ensure a Social and
Physical Environment which improves, promotes and
protects the public health and whanau public
healthLongevity and quality of life .

• Objectives/Targets1998
• Oral health
• Breastfeeding
• Foods and nutrients
• Physical activity
• Obesity
• Hazardous substances (poisonings)

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Swedish Public Health PolicyAn obvious relation
between the goals and political actions to
achieve themMain area of public health becomes
placed outside the health medical
sectorMental health self-reported health
decreasing especially among the young

• 1. Participation influence in society
• 2. Economic social security
• 3. Secure favorable conditions in childhood
  adolescence esp unemployment
• 4. Healthier working life
• 5. Healthy safe environments products
• 6. Health medical care that actively promotes
  health

Agren 2004
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Barriers/Competitors

• Politics, Politics, Politics
• Government Depts
• Use of Criminal Justice System
• Corporations Vested interests Professional
  Attitudes
• Public Attitudes

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Strategic Thinking Other learnings from
commercial marketing
Marketing warfare strategies In mature, low
growth markets, gain is only possible at the
competitors expense
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Identify the enemy Wealth Power Pyramid
2-3 47 of wealth
Rich Owners ruling class
17-18
44 of wealth Middle
professional managers Work for Owners
80
9 of wealth Front line workers,
working poor Welfare, unemployed, homeless
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Marketing WarfareIn mature, low growth
markets, gain is only possible at the
competitors expenseRedistribution of finite
resources only possible at the elites expense
went out of fashion cos collaboration better for
them than competition
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Marketing warfare strategies Activism

• Napoleon.
• The element of surprise
• Units who know each other, variety and different
  levels of skills
• Look after suppliers/facilitators
• Strike at the enemys lines of supply
• Offensive
• Defensive
• Flanking
• Guerilla Wear down enemy by long series of minor
  attacks at weak points
• targeted legal attacks on competition product
  comparison advertising executive raiding Lion
  Nathan?
• deliberate sabotage of competitions test
  markets, ad campaigns, sales promotions
  orchestrate negative publicity for competitor

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Principles of non violent protest
Even the most powerful cannot govern without
the cooperation of the ruledGhandis
Sattyagraha generate reactions that shock
the population generate maximal publicity for
the retaliation select actions (1) supported
by vast majority of affected group
(2) seen to be realistic/efficaceous (3)
substantial non group only lukewarm (non brand
loyals) (4) that have an economic impact

• acceptable leader to wider population
• enlist partners, allies, spokespersons

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Principles of non violent protest strategic
planning, coordination and training.
segmentation promote the core product to
leaders tangible products to the affected
populations. exchange for participation
benefits must outweigh the (sometimes
considerable) costs exchange for the
opposition we will cooperate if you change the
law strategic place considerations
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Social Marketings Troops

• People in the buffer zone need to adopt a
  marketing orientation are we there to provide
  a social service or to assist in social change?
  Paul Kivel
• Public service requires example from the top
  ...
• NGOs

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Social Marketings Required New Understandings,
New Sourcesand Resources

• Neuropsychology
• Sociology social change movements
• Global Economics
• Public Health social justice equity
• Government policy making
• Environmental planning

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• Religion
• Liberation Theology
• Education
• Citizenship morals, values
• Philosophy
• Politics the study of power
• The law
• New ideas, new leaders, new partners .

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Social EntrepreneursDuggan 2004 MEE-zine Dec 7
2004
Social entrepreneur uses earned income to
achieve social financial objectives Not just
providing fish, not teaching how to fish, but
changing the fishing industry Food
security coalitions farmers markets mobile
markets bypass traditional intermediaries
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• Legal Advocates
• Steven Kazan USA asbestosis
• (Slater Gordon AUS)
• Goals
• 1. Go as far as possible within legal system to
  redress the wrong to clients
• 2. Improve the workplace thru public education
  about occupational health and safety and through
  legislative advocacy

52
(No Transcript)
53

• Community University
• Activist Groups
• RMIT Community Group
• Social Sciences courses
• Leaders .

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Leadership Whos gunna fill their shoes?George
Joneswhere have all the leaders gone
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Social or Liberation Medicine
The revolutions taskthe task of training and
nourishing the children, the task of educating
the army, the task of distributing the lands of
the old absentee landlords among those who
sweated every day on that same land without
reaping its fruitis the greatest work of social
medicine that has been done in Cuba. (Cited in
David Deutschmann, ed., Che Guevara A Reader
Writings on Guerilla Strategy, Politics and
Revolution New York, Ocean Press, 1997.)
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• The Mockus Approach
• philosophical principles
• educational objectives
• normative change strategies
• edutainment tactics
• community and stakeholder participation
• constant personal media presence
• The distribution of knowledge is the key
  contemporary task. Knowledge empowers people. If
  people know the rules, and are sensitised by art,
  humour and creativity, they are much more likely
  to accept change
• Socrates if people understood well, they would
  probably not act in the wrong way

• 420 mimes to control traffic thumbs up,
  thumbs down signs
• Night for women --- reclaim the streets
  700,000
• Water avings
• Closed bars at 1am
• Restored value of human life homicides 80/100k
  in 93 to 22 in 2003 pedestrian road deaths
• Protection of children
• Increased drinking water 79 to 100 and sewage
  services 70 to 95 of homes
• Vaccine against violence
• Schools of Civic Security and local security
  fronts 7000

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Summing up . Early marketing exchanges
brought people together established enduring
relationships community cohesion getting
together Marketing to serve capitalism became
part of the expansion driven ethos and
exploitation of natural resources getting
ahead Social marketing is fixated on the
marketing in social marketing and the
lifestyle risk factors of early health
promoters
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Summing up . If our overall goal is well
being, need to shift emphasis from physical
health to mental health and the social
determinants of well being In the global
village, this means equitable distribution of
finite global resources where the competition
is for political power . between international
corporations and the people NZ no need for
review of acl advtg Dominion 10/3/05 While
continuing our standard social marketing
campaigns we need to form new partnerships, learn
new skills, gather our strengths and become
leaders of a social movement GH .